Reliability and item content of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT): Parts 1–3

Abstract

The success of early intervention programs has in large part spurred increasing emphasis on identifying children with autism and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) at the earliest possible ages. National and international professional groups have called for early screening and diagnosis, yet the technology to effectively meet these goals are insufficient. The Checklist for Autism in Toddlers (CHAT) and its variants is the only scale with acceptable psychometrics at present, but measures autism only. In this paper we describe a new measure, the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT), which is geared toward identifying young children with autism and PDD-NOS, and which also assesses for comorbid psychopathology and challenging behaviors. This initial study describes item selection and reliability for all three parts of the measure, which were individually administered to the parents of 276 children ages 17–37 months identified as at risk for developmental and/or physical disabilities.

Introduction

Autism Spectrum Disorders (ASD) are a set of neurodevelopmental conditions characterized by deficits in communication, social skills, and rituals and stereotypies (Matson, 2007a; Matson & Boisjoli, 2007; Matson & Wilkins, 2008a; Njardvik, Matson, & Cherry, 1999; Paclawskyj, Rush, Matson, & Cherry, 1999). One of the topics that has generated the greatest interest among parents, the popular press, and researchers in ASD is early detection and diagnosis (Lord & Luyster, 2006; Matson, Wilkins, & González, 2008). This trend, in large part, is bolstered by the fact that early intervention for children as young as 18 months to 2 years may be advisable (Ben-Itzchak, Lahat, Burgin, & Zachor, 2008; Matson & Smith, 2008). Despite this fact, no biological or genetic tests for the condition have been developed (Theoharides, Doyle, Francis, Conti, & Kalogeromitros, 2008). Therefore, the emphasis has been most fruitful in the area of scales which can be used to assess developmental skill sets and whether they deviate from the norm (Matson et al., 1996, Matson et al., 1998).

To date, only one methodologically sound measure for early identification has been developed specific to early detection. This measure, the Checklist for Autism in Toddlers (CHAT; Baron-Cohen, Allen, & Gillberg, 1992), has undergone additional revisions: the Modified Checklist for Autism in Toddlers (M-CHAT; Robins, Fein, Barton, & Green, 2001) and the Quantitative Checklist for Autism in Toddlers (Q-CHAT; Allison et al., in press), which is in development. This measure has promise but is limited to autism and is a screening instrument not aimed at aiding in diagnosis.

More recently, the Autism Spectrum Disorders Child Battery has been developed. The purposes of this measure are to aid in the diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), autism, and Asperger's syndrome. Additionally, it was devised to assess comorbid psychopathology and challenging behaviors. Good reliability and validity have been reported (Matson et al., 2008a, Matson et al., 2008c; Matson & Wilkins, 2008b).

The purpose of the present study was to extend this scale by using the same diagnostic categories and to test these items and overall content with very young children. This version of the scales was dubbed the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A biscuit is defined as a small, sweet cake. Small and sweet are apt descriptions of the young children assessed. This study was aimed at establishing the reliability of all three parts of the BISCUIT (diagnostic, comorbid, challenging behaviors) with a sample of “at risk” children ages 13–37 months.